GENITOURINARY DISORDERS - Medicine for Mountaineering and Other Wilderness Activities - page 296

or an indwelling Foley catheter. Predicting who would need only a single catheterization
is infeasible, with the possible exception of individuals whose retention is clearly due to a
drug that is expected to wear off.
Foley catheters with leg bags are the treatment of choice in the wilderness. This type
of catheter has a small balloon just below the tip. After the catheter has been inserted, this
ballooncanbeinflatedbyinjectingfluidwithasyringeandneedleintothenippleprovided
for this purpose on the external end of the catheter. The balloon must be deflated by clip-
ping off the end of the nipple before the catheter is withdrawn. However, a catheter of this
kind can usually be left in place for up to three days.
OTHER URINARY TRACT DISORDERS
Kidney (Renal) Stones
Since the characteristic symptom of kidney stones is severe pain, this disorder is dis-
cussed in Chapter 20: Acute Abdominal Pain . Bloody urine and burning with voiding can
also accompany the passage of a stone.
Hematuria
In residents of developed countries, hematuria (bloody urine) may be associated with
traumatic injuries or tumors of the urinary tract, as well as the disorders previously dis-
cussed, most commonly cystitis. Schistosomiasis and—less commonly—tuberculosis are
causes encountered in residents of developing countries. Traumatic urinary disorders are
discussed in Chapter 10: Abdominal Injuries . Adequate treatment for tumors is impossible
in the wilderness.
Visibly bloody urine produced by cystitis usually disappears in about twenty-four hours
and is accompanied by symptoms of cystitis. In the absence of signs of a specific disorder,
hematuria should prompt immediate medical consultation to determine the cause and insti-
tute appropriate therapy. Hematuria can be an indication of a serious disorder. (The loss of
blood itself is almost never of sufficient volume to be disabling.)
Hemoglobinuria
Severe injuries, severe infections, burns, and other disorders can destroy red blood cells
andreleasehemoglobinintotheblood.Thispigmentisexcretedbythekidneysandimparts
to the urine a faint pink to deep red color that resembles bloody urine.
Hemoglobinuria must be distinguished from hematuria, which is caused by entirely dif-
ferent conditions. If urine that contains hemoglobin is permitted to stand, no blood settles
to the bottom of the container. Acute renal failure sometimes follows disorders producing
hemoglobinuria if the individual becomes dehydrated or goes into shock. Immediate ad-